Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/36458 http://dx.doi.org/10.3171/2013.4.SPINE12319 |
Resumo: | Object. Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. the influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. the authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale.Methods. the study was performed as an institutional review board approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%-24% loss of postoperative disc height; Grade I, 25%-49%; Grade II, 50%-74%; and Grade III, 75%-100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded.Results. Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383).Conclusions. Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale. |
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Marchi, Luis [UNIFESP]Abdala, Nitamar [UNIFESP]Oliveira, LeonardoAmaral, RodrigoCoutinho, EtevaldoPimenta, LuizUniversidade Federal de São Paulo (UNIFESP)Inst Patol ColunaUniv Calif San Diego2016-01-24T14:31:55Z2016-01-24T14:31:55Z2013-07-01Journal of Neurosurgery-spine. Rolling Meadows: Amer Assoc Neurological Surgeons, v. 19, n. 1, p. 110-118, 2013.1547-5654http://repositorio.unifesp.br/handle/11600/36458http://dx.doi.org/10.3171/2013.4.SPINE1231910.3171/2013.4.SPINE12319WOS:000320739600016Object. Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. the influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. the authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale.Methods. the study was performed as an institutional review board approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%-24% loss of postoperative disc height; Grade I, 25%-49%; Grade II, 50%-74%; and Grade III, 75%-100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded.Results. Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383).Conclusions. Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale.Universidade Federal de São Paulo, Dept Imaging Diag, São Paulo, BrazilInst Patol Coluna, Dept Minimally Invas Surg, São Paulo, BrazilUniv Calif San Diego, Dept Neurosurg, San Diego, CA 92103 USAUniversidade Federal de São Paulo, Dept Imaging Diag, São Paulo, BrazilWeb of Science110-118engAmer Assoc Neurological SurgeonsJournal of Neurosurgery-spineminimally invasivecomplicationlumbar fusionXLIFspinearthrodesisspinal fusionRadiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP11600/364582022-06-02 09:05:56.106metadata only accessoai:repositorio.unifesp.br:11600/36458Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652022-06-02T12:05:56Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article |
title |
Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article |
spellingShingle |
Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article Marchi, Luis [UNIFESP] minimally invasive complication lumbar fusion XLIF spine arthrodesis spinal fusion |
title_short |
Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article |
title_full |
Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article |
title_fullStr |
Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article |
title_full_unstemmed |
Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article |
title_sort |
Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article |
author |
Marchi, Luis [UNIFESP] |
author_facet |
Marchi, Luis [UNIFESP] Abdala, Nitamar [UNIFESP] Oliveira, Leonardo Amaral, Rodrigo Coutinho, Etevaldo Pimenta, Luiz |
author_role |
author |
author2 |
Abdala, Nitamar [UNIFESP] Oliveira, Leonardo Amaral, Rodrigo Coutinho, Etevaldo Pimenta, Luiz |
author2_role |
author author author author author |
dc.contributor.institution.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) Inst Patol Coluna Univ Calif San Diego |
dc.contributor.author.fl_str_mv |
Marchi, Luis [UNIFESP] Abdala, Nitamar [UNIFESP] Oliveira, Leonardo Amaral, Rodrigo Coutinho, Etevaldo Pimenta, Luiz |
dc.subject.eng.fl_str_mv |
minimally invasive complication lumbar fusion XLIF spine arthrodesis spinal fusion |
topic |
minimally invasive complication lumbar fusion XLIF spine arthrodesis spinal fusion |
description |
Object. Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. the influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. the authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale.Methods. the study was performed as an institutional review board approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%-24% loss of postoperative disc height; Grade I, 25%-49%; Grade II, 50%-74%; and Grade III, 75%-100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded.Results. Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383).Conclusions. Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale. |
publishDate |
2013 |
dc.date.issued.fl_str_mv |
2013-07-01 |
dc.date.accessioned.fl_str_mv |
2016-01-24T14:31:55Z |
dc.date.available.fl_str_mv |
2016-01-24T14:31:55Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Journal of Neurosurgery-spine. Rolling Meadows: Amer Assoc Neurological Surgeons, v. 19, n. 1, p. 110-118, 2013. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/36458 http://dx.doi.org/10.3171/2013.4.SPINE12319 |
dc.identifier.issn.none.fl_str_mv |
1547-5654 |
dc.identifier.doi.none.fl_str_mv |
10.3171/2013.4.SPINE12319 |
dc.identifier.wos.none.fl_str_mv |
WOS:000320739600016 |
identifier_str_mv |
Journal of Neurosurgery-spine. Rolling Meadows: Amer Assoc Neurological Surgeons, v. 19, n. 1, p. 110-118, 2013. 1547-5654 10.3171/2013.4.SPINE12319 WOS:000320739600016 |
url |
http://repositorio.unifesp.br/handle/11600/36458 http://dx.doi.org/10.3171/2013.4.SPINE12319 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
Journal of Neurosurgery-spine |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
110-118 |
dc.publisher.none.fl_str_mv |
Amer Assoc Neurological Surgeons |
publisher.none.fl_str_mv |
Amer Assoc Neurological Surgeons |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
|
_version_ |
1802764103885783040 |